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- Lewis, Tamorah R., et al.
(författare)
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Association of Racial Disparities With In-Hospital Outcomes in Severe Bronchopulmonary Dysplasia
- 2022
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Ingår i: JAMA pediatrics. - : American Medical Association (AMA). - 2168-6203 .- 2168-6211. ; 176:9, s. 852-859
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Tidskriftsartikel (refereegranskat)abstract
- Importance: Bronchopulmonary dysplasia (BPD) is the most common serious morbidity of preterm birth. Short-term respiratory outcomes for infants with the most severe forms of BPD are highly variable. The mechanisms that explain this variability remain unknown and may be mediated by racial disparities.Objective: To determine the association of maternal race with death and length of hospital stay in a multicenter cohort of infants with severe BPD.Design, setting, and participants: This multicenter cohort study included preterm infants enrolled in the BPD Collaborative registry from January 1, 2015, to July 19, 2021, involving 8 BPD Collaborative centers located in the US. Included patients were born at less than 32 weeks' gestation, had a diagnosis of severe BPD as defined by the 2001 National Institutes of Health Consensus Criteria, and were born to Black or White mothers.Exposures: Maternal race: Black vs White.Main outcomes and measures: Death and length of hospital stay.Results: Among 834 registry infants (median [IQR] gestational age, 25 [24-27] weeks; 492 male infants [59%]) meeting inclusion criteria, the majority were born to White mothers (558 [67%]). Death was observed infrequently in the study cohort (32 [4%]), but Black maternal race was associated with an increased odds of death (adjusted odds ratio, 2.1; 95% CI, 1.2-3.5) after adjusting for center. Black maternal race was also significantly associated with length of hospital stay (adjusted between-group difference, 10 days; 95% CI, 3-17 days).Conclusions and relevance: In a multicenter severe BPD cohort, study results suggest that infants born to Black mothers had increased likelihood of death and increased length of hospital stay compared with infants born to White mothers. Prospective studies are needed to define the sociodemographic mechanisms underlying disparate health outcomes for Black infants with severe BPD.
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- Schwid, SR, et al.
(författare)
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Enhanced benefit of increasing interferon beta-1a dose and frequency in relapsing multiple sclerosis - The EVIDENCE study
- 2005
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Ingår i: Archives of Neurology. - 0003-9942. ; 62:5, s. 785-792
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Tidskriftsartikel (refereegranskat)abstract
- Background: The EVIDENCE (Evidence of Interferon Dose-Response: European North American Comparative Efficacy) Study demonstrated that patients with multiple sclerosis (MS) who initiate interferon beta-la therapy with 44 μ g 3 times weekly (TIW) were less likely to have a relapse or activity on magnetic resonance imaging (MRI) compared with those who initiate therapy at a dosage of 30 μ g 1 time weekly (QW). Objective: To determine the effect of changing the dosage from 30 μ g QW to 44 μ g TIW in this extension of the EVIDENCE StudyDesign/Patients: Patients with relapsing MS originally randomized to interferon beta-1a, 30 μ g QW, during the comparative phase of the study changed to 44 μ g TIW, whereas patients originally randomized to 44 μ g TIW continued that regimen. Patients were followed up, on average, for an additional 32 weeks. Main Outcome Measure: The within-patient pretransition to posttransition change in relapse rate. Results: At the transition visit, 223 (73%) of 306 patients receiving 30 μ g QW converted to 44 μ g TIW, and 272 (91%) of 299 receiving 44-μ g TIW continued the same therapy. The posttransition annualized relapse rate decreased from 0.64 to 0.32 for patients increasing the dose (P<.001) and from 0.46 to 0.34 for patients continuing 44-μ g TIW (P =.03). The change was greater in those increasing dose and frequency (P=.047). Patients converting to the 44-μ g,TIW regimen had fewer active lesions on T2-weighted MRI compared with-before the transition (P=.02), whereas those continuing the 44-μ g TIW regimen had no significant change in T2 active lesions. Patients who converted to high-dose/high-frequency interferon beta-la therapy had increased rates of adverse events and treatment terminations consistent with the initiation of high-dose subcutaneous interferon therapy. Conclusions: Patients receiving interferon beta-la improved on clinical and MRI disease measures when they changed from 30μ g QW to 44 μ g TIW.
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- Sindelar, Richard, Docent, 1964-, et al.
(författare)
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Established severe BPD: is there a way out? Change of ventilatory paradigms
- 2021
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Ingår i: Pediatric Research. - : Springer Nature. - 0031-3998 .- 1530-0447. ; 90:6, s. 1139-1146
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Tidskriftsartikel (refereegranskat)abstract
- Improved survival of extremely preterm newborn infants has increased the number of infants at risk for developingbronchopulmonary dysplasia (BPD). Despite efforts to prevent BPD, many of these infants still develop severe BPD (sBPD) andrequire long-term invasive mechanical ventilation. The focus of research and clinical management has been on the prevention ofBPD, which has had only modest success. On the other hand, research on the management of the established sBPD patient hasreceived minimal attention even though this condition poses large economic and health problems with extensive morbidities andlate mortality. Patients with sBPD, however, have been shown to respond to treatments focused not only on ventilatory strategiesbut also on multidisciplinary approaches where neurodevelopmental support, growth promoting strategies, and aggressivetreatment of pulmonary hypertension improve their long-term outcomes. In this review we will try to present a physiology-basedventilatory strategy for established sBPD, emphasizing a possible paradigm shift from acute efforts to wean infants at all costs to amore chronic approach of stabilizing the infant. This chronic approach, herein referred to as chronic phase ventilation, aims atallowing active patient engagement, reducing air trapping, and improving ventilation-perfusion matching, while providingsufficient support to optimize late outcomes.
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